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Risk factors for negative sputum acid-fast bacilli smears in pulmonary tuberculosis: results from Dakar, Senegal, a city with low HIV seroprevalence

Authors: Samb, B.1; Sow, P. S.2; Kony, S.1; Maynart-Badiane, M.2; Diouf, G.2; Cissokho, S.2; Bâ, D.2; Sané, M.3; Klotz, F.3; Faye-Niang, M. A.2; Mboup, S.4; Ndoye, I.5; Delaporte, E.6; Hane, A. A.2; Samb, A.2; Coulaud, J.-P.7; Coll-Seck, A. M.2; Larouzé, B.1; Murray, J. F.8

Source: The International Journal of Tuberculosis and Lung Disease, Volume 3, Number 4, April 1999 , pp. 330-336(7)

Publisher: International Union Against Tuberculosis and Lung Disease

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Abstract:

SETTING: Two teaching hospitals in Dakar, Senegal, a West African country with a low prevalence of human immunodeficiency virus (HIV) infection.

OBJECTIVE: To determine whether patients with HIV-associated pulmonary tuberculosis have fewer acid-fast bacilli (AFB) in their sputum as assessed by routine microscopy, and to correlate the findings with systematically obtained clinical, radiographic and laboratory variables.

DESIGN: Prospective study from November 1995 to October 1996 of 450 consecutive patients diagnosed with pulmonary tuberculosis.

RESULTS: Tuberculosis was diagnosed in 380 patients (84.4%) by positive bacteriology, in 61 (13.6%) by a favorable response to anti-tuberculosis chemotherapy, and in nine (2.0%) by the presence of a miliary radiographic pattern. Forty (8.9%) patients were HIV-seropositive. AFB-negative smears were found in 14/40 (35.0%) of the HIV-seropositive patients with pulmonary tuberculosis compared with 71/410 (17.3%) of the seronegative patients (risk ratio [RR] = 2.02, 95% confidence interval [CI] 1.26–3.24, P = 0.01). Multivariate analysis revealed that AFB smear negativity was associated with absence of cavitation (P = 0.002), lack of cough (P = 0.005), the presence of HIV seropositivity (P = 0.02), a CD4+ cell count above 200/mm3 (P = 0.02), and age over 40 years (P = 0.03).

CONCLUSIONS: Compared with HIV-seronegative patients with pulmonary tuberculosis, seropositive patients in Dakar, Senegal, are more likely to have negative sputum-AFB smears. This phenomenon has now been observed in seven of eight sub-Saharan African countries with varying HIV seroprevalence from which reports are available.

Keywords: HIV infection; West Africa; acid-fast bacilli; tuberculosis

Document Type: Regular Paper

Affiliations: 1: INSERM U13/IMEA, Paris, France 2: CHU de Fann, Dakar, Sénégal 3: Hôpital Principal, Dakar, Sénégal 4: Hôpital A Le Dantec, Dakar, Sénégal 5: Institut d'Hygiène Sociale, Dakar, Sénégal 6: ORSTOM, Laboratoire des Rétrovirus, Montpellier, France 7: Hôpital Bichat-Claude Bernard, Paris, France 8: University of California San Francisco, San Francisco, California, USA

Publication date: April 1, 1999

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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